Vol. 42 n. 3 May . June, 2016

The May-June 2016 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Urinary Incontinence, Urethral Stricture, Bladder Cancer, Pelvic-Ureteric Junction Stenosis, BPH, Prostate Cancer, Renal stones, Uroginecology, Pediatric Urology and basic research…

EDITOR’S COMMENT – Bucal Mucosa Graft in Long Anterior Urethral Stenosis – Dorsal or Ventral?

Vol. 42 (2): 407-408, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2016.03.01


EDITOR’S COMMENT

Bucal Mucosa Graft in Long Anterior Urethral Stenosis – Dorsal or Ventral?

The May-June 2016 issue of the International Braz J Urol presents original contri¬butions with a lot of interesting papers in different fields: Urinary Incontinence, Urethral Stricture, Bladder Cancer, Pelvic-Ureteric Junction Stenosis, BPH, Prostate Cancer, Renal stones, Uroginecology, Pediatric Urology and basic research. The papers come from many different countries such as Brazil, USA, Turkey, Italy, Austria, Australia, Israel, Netherlan¬ds, India, Mexico, China, Saudi Arabia, United Kingdon, Korea and France, and as usual the editor ́s comment highlights some papers. We decided to comment 2 papers about a very usual topic in urologic practice: The Urethral Stricture.
Doctor Prabha and collegues from India performed on page 564 an interesting study about the single stage dorsolateral onlay buccal mucosal urethroplasty for long an-terior urethral strictures. The authors studied 20 patients with urethral strictures: Lichen sclerosis in 12 cases (60%), Instrumentation in 5 cases (25%), and unknown in 3 cases (15%). Strictures were approached through a perineal skin incision and penis was invagi-nated into it to access the entire urethra. All the grafts were placed dorsolaterally, preser¬ving the bulbospongiosus muscle, central tendon of perineum and one-sided attachement of corpus spongiosum. The mean stricture length was 8.5cm (range 4 to 12cm) and the overall success rate was 85%. There were 3 failures (meatal stenosis in 1, proximal stric¬ture in 1 and whole length recurrent stricture in 1). Other complications included wound infection, urethrocutaneous fistula, brownish discharge per urethra and scrotal edema. The authors concluded that dorsolateral buccal mucosal urethroplasty for long anterior urethral strictures using a single perineal incision is simple, safe and easily reproducible by urologists with a good outcome.
The success of urethroplasty using bucal mucosa graft (BMG) is significantly bet-ter compared to others grafts (1). The BMG placement can be ventral, dorsal and lateral, but the first 2 are most commonly done (2). Dorsal placement of the graft has the ad-vantage of using the corporal bodies to provide a secure well-vascularized graft bed that helps to prevent the protrusion of the graft with resulting pseudodiverticulum formation (3). Ventral location provides the advantages of ease of exposure and good vascular su-pply by avoiding circumferential rotation of the urethra (4). Early success rates of dorsal and ventral onlay with BMG were 96 and 85%, respectively. However, long-term follow¬-up revealed essentially no difference in success rates (5-8). Most recently, in a interestig meta-analysis review of the literature on dorsal or ventral graft urethroplasty the success rates of ventral onlay urethroplasty (750 cases) and dorsal onlay (513 cases) were 82.5 and 86.9% (p = 0.034) (9).
We can conlude that the two techniques (Ventral and Dorsal BMG) had similar su¬cess results in long anterior urethral strictures and the surgeon experience and preference with the technique is the most important factor for the sucess of the surgery.

REFERENCES

1.    Lumen N, Oosterlinck W, Hoebeke P. Urethral reconstruction using buccal mucosa or penile skin grafts: systematic review and meta-analysis. Urol Int. 2012;89:387-94.
2.    Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol. 2005;174:955-7; discussion 957-8.
3.    Iselin CE, Webster GD. Dorsal onlay graft urethroplasty for repair of bulbar urethral stricture. J Urol. 1999;161:815-8.
4.    Wessells H. Ventral onlay graft techniques for urethroplasty. Urol Clin North Am. 2002;29:381-7, vii.
5.    Singh O, Gupta SS, Arvind NK. Anterior urethral strictures: a brief review of the current surgical treatment. Urol Int. 2011;86:1-10.
6.    Barbagli G, Selli C, Tosto A, Palminteri E. Dorsal free graft urethroplasty. J Urol. 1996;155:123-6.
7.    Andrich DE, Mundy AR. Substitution urethroplasty with buccal mucosal-free grafts. J Urol. 2001;165:1131-3; discussion 1133-4.
8.    Kane CJ, Tarman GJ, Summerton DJ, Buchmann CE, Ward JF, O’Reilly KJ, Ruiz H, Thrasher JB, Zorn B, Smith C, Morey AF. Multi-institutional experience with buccal mucosa onlay urethroplasty for bulbar urethral reconstruction. J Urol. 2002;167:1314-7.
9.    Wang K, Miao X, Wang L, Li H. Dorsal onlay versus ventral onlay urethroplasty for anterior urethral stricture: a meta-analysis. Urol Int. 2009;83:342-8.

Luciano A. Favorito, MD, PhD
Professor Associado da Unidade de Pesquisa Urogenital da Universidade do Estado de Rio de Janeiro
Urologista do Hospital da Lagoa Federal, Rio de Janeiro
Editor Associado da International Braz J Urol

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EDITORIAL IN THIS ISSUE – From robot to molecule, the behavior

Vol. 42 (2): 409-412, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2016.03.02


EDITORIAL IN THIS ISSUE

From robot to molecule, the behavior

In general Urology, forty per cent of ambulatory consultations are intended to prostate care, as well as consultation in geriatrics and clinical medicine. It is observed statistically that one in every six men over 50 years will present prostate cancer (PCa) throughout live (1). It is the second most prevalent cancer in men, following skin cancer, with an estimate of 61,200 new cases in 2016, according to INCA (National Cancer Institute of Brazil).
Recent scientific knowledge and incorporation of new technologies lead to higher interaction with molecular epidemiology and cancer genetics. They explain why some patients will present slower progression of the disease, allowing for active surveillance, and also the use of newer and lesser aggressive treatments with higher survival with good quality of life. Epigenetic and genetic alterations provide a mosaic of tumor clones that determine respectively heterogeneous histologically phenotypic tumors, with corresponding indolent clinical symptoms or a more aggressive progression (2).
Currently, renal tumors are efficiently treated due to precision and richer details provided by modern image technologies. We are able to detect in daily practice the aggressiveness of the lesion according to dimension, morphology, tissue density, perfusion and anatomic relations, allowing the choice of the most adequate treatment. Actually, current image exams reflect more accurately the tumor microenvironment.  In the same way, evaluation of prostate gland by multiparametric magnetic resonance provides data related to morphology, perfusion, diffusion and spectroscopy, that matches more adequately tumor histology and neoplastic alterations of PCa. After 2010, based on the BIS-RADS model system, Breast Imaging and Reporting Archiving Data System, many studies have been proposed to study the prostate gland. PI-RADS, Prostate Imaging and Reporting Archiving Data System, was proposed to determine image patterns obtained by MRI of PCa, in order to distinguish between “insignificant lesions” and clinical significant lesions, and to determine where to perform biopsy (prostate targets). In 2012 European Urology magazine proposed a guideline using PI-RADS system with five grades of suspicion of prostate cancer. In the first two grades, it is unlikely the presence of clinical significant disease and biopsy is not recommended; grade three is undetermined and the last two grades present respectively increased rate of predictive value/positivity of prostate cancer, determining the need of prostate biopsy (3). This method of prostate evaluation presents an intrinsic correlation of histopathological findings according to Gleason system and morphological and functional images classified according to PI-RADS system, related to the molecular content of tumor cells. This classification allows for therapeutic variations, from active surveillance to minimally invasive focal ablations or radical surgeries and expanded lymphadenectomy. The better understanding of cellular signal alterations of prostate cancer resulted in the development of new treatments, such as the new generation of anti-androgens.
In a similar way, Gleason system has been modified over the years since its first publication. It is a morphological and analogical system fundamental to diagnostic, prognostic and treatment of prostate cancer. In November 2014 a new recommendation of International Society of Urological Pathology (ISUP), proposed the grouping of scores in five categories (4), based on the recognition that previous score valued some benign lesions (Table-1).


Table 1 – New recommendation of International Society of Urological Pathology (ISUP) (4).

Grade I Score 3 + 3
Grade II Score 3 + 4
Grade III Score 4 + 3
Grade IV Score 8 (3 + 5, 5 + 3  and 4 + 4)
Grade V Score 9 and 10 (4 + 5, 5 + 4 and 5 + 5)

 


This valuable system of morphological classification of prostate tissue since the beginning showed the heterogeneity of tumor histological findings present in the same gland with obvious different biological behavior and distinct evolution according to focus, making treatment approach complex.  These variations of PCa histology are being scientifically endorsed, correlating each grade of Gleason scale with a respective profile of genic expressions, related to a specific assortment of carcinogenic cell signals, that will act as tumor progression markers. Welsh et al work described 20 genes with different expressions correlated to three grades of Gleason score. Insulin-binding proteins (IGFRP 2 and 5) were expressed in higher grade tumors (5).
Current urological practice is guided by a clinical rationale based on molecular biology of PCa, and urologists, pathologists and oncologists apply laboratory research data and clinical daily practice evidences in clinical treatments.
In the current treatment of our patients, it is mandatory to understand proliferation and cellular differentiation according to epigenetics, cellular cycle regulations and possible alterations of signalization among androgens, co-activators and androgen receptors.
Many years have passed in order to aware global male population about the importance of early diagnosis of prostate cancer, with unquestionable positive results. But current prostate cancer screening methods are controversial and maybe the explanation of these troublesome epidemiological polemics is based on the PCa heterogeneity including molecular aspects and familiar history; the understanding of those aspects may help us redirect PCa screening.
For many years, it has been shown that first degree relatives with PCa and relatives with breast cancer with less than 36 years old increase four-fold the chance of PCa. Five to 10% of all cancer are hereditary transmitted by mutations that occurred in germ cells, being defined as constitutional tumors. Hereditary cancer usually presents more clinical and aggressive evolution. It is mandatory to have in mind that individuals are born frequently with loss of one of two tumor genic suppressor activity alleles. Consequently, timing of phenotypically expression of tumor is shortened when the remaining “health’ allele loses its function. This is the concept that explain predisposing syndromes of cancer, and typical examples of hereditary cancer are breast and colon tumors.  Although it is not described a specific characterization of hereditary prostate cancer, others syndromes of hereditary tumors that include PCa are known (6). Also, PCa presents a great number of studied polymorphisms that explains the genesis of PCa (common genetic alteration of general population that may predispose to tumor (6, 7)) (Table-2).


Table 2 – Genes more involved in PCa (7).

Gene Gene Gene
DAB2IP HERC2 LEPR
IL4 RNASEL CRY
ARCF HOXB13 OGGI
HPC1 HPC2 MSR1
PON1 MIC1 BRCA1 / BRCA2

 


It is recommended during anamnesis to construct a heredogram in men over 40 years old with at least three generations by which it is possible to choose individual preventive measures mainly for hereditary syndrome of breast and ovary cancer (HBOC) whose sites are closely related to PCa. Hereditary tumors usually present some of the following characteristics (8):

1. Increase number of cases in a particular population
2. Multiple cases in the same family, involving many generations
3. Bilateral tumors, or more than one primary tumor in the same individual, synchronous or metachronous
4. Rare histological type of tumors
5. Cases in younger age than in general population

Currently, we observe the duel between professional performance and surgical technique of robotic laparoscopic radical prostatectomy compiling results and complications, and each urologist is invited to analyze his personal limits and personal skills. Also, the urologists are presented with several forms of treatment, from resection of advanced tumors to simple clinical observation and the use of new drugs that interact with molecular signs, such as abiraterone and enzalutamide and he must adequately understand molecularly the phenomena and their clinical consequences.
In conclusion, it is important to recognize and understand that molecules determine distinct biological behaviors and when we are able to identify and assimilate different molecular profiles we will be capable to practice a precision medicine, with adequate treatment of our patients, from simple surveillance to robotic surgery.

REFERENCES

1.    Próstata: isso é com você, Srougi M. 2003; Publifolha pp. 9.
2.    Easwaran H, Tsai HC, Baylin SB. Cancer epigenetics: tumor heterogeneity, plasticity of stem-like states, and drug resistance. Mol Cell. 2014;54:716-27.
3.    Barentsz JO, Weinreb JC, Verma S, Thoeny HC, Tempany CM, Shtern F, et al. Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance Imaging and Recommendations for Use. Eur Urol. 2016;69:41-9.
4.    Delahunt B, Egevad L, Samaratunga H, Martignoni G, Nacey JN, Srigley JR. Gleason and Fuhrman no longer make the grade. Histopathology. 2016;68:475-81.
5.    Brum IS, Spritzer PM, Brentani MM. Molecular biology in the prostate neoplasia. Arq Bras Endocrinol Metabol. 2005;49:797-804.
6.    Demichelis F, Stanford JL. Genetic predisposition to prostate cancer: Update and future perspectives. Urol Oncol. 2015;33:75-84.
7.    Goh CL, Schumacher FR, Easton D, Muir K, Henderson B, Kote-Jarai Z, et al. Genetic variants associated with predisposition to prostate cancer and potential clinical implications. J Intern Med. 2012;271:353-65. Erratum in: J Intern Med. 2013;273:527.
8.    Lindor NM, Greene MH. The concise handbook of family cancer syndromes. Mayo Familial Cancer Program. J Natl Cancer Inst. 1998;90:1039-71.

Julio Bernardes, MD, PhD
Prof. Adjunto de Urologia – UFPA (Universidade Federal do Pará)
Discente de doutorado do PPGOCM – Núcleo de Pesquisas em Oncologia / UFPA
Hospital Universitário João de Barros Barreto, 2º Piso da UNACON
Rua dos Mundurucus, 4487, Guamá
Belém, PA, 66073-005, Brasil
E-mail: juliobernardes@oi.com.br

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Active surveillance in Gleason 7 intermediate risk prostate cancer: is it safe?

Vol. 42 (3): 413-417, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2016.03.03


DIFFERENCE OF OPINION

Active surveillance in Gleason 7 intermediate risk prostate cancer: is it safe?
Opinion: Yes

Henk G. van der Poel 1, Roderick C.N. van den Bergh 2

1 Department of Urology, Netherland Cancer Institute, Amsterdam, The Netherlands; 2 Department of Urology, Royal Melbourne Hospital/Peter MacCallum Cancer Centre, Melbourne, Australia


Keywords: Prostatic Neoplasms; Prostate cancer, familial [Supplementary Concept]; Watchful Waiting; Disease; Therapeutics


Most men with prostate cancer will not die from it. Although the most frequent cancer in men in the western world it ranks only 3rd place for cause of death (1). In men over 60 years of age prostate cancer is found at autopsy in over 60% (2). Overdiagnosis by PSA screening is estimated to be 57% when screened until 75 years of age (3). Considering treatment toxicity, careful selection of men for treatment is essential. A shift towards more conservative management is apparent in larger registries (4, 5).

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Active surveillance in Gleason 7 intermediate risk prostate cancer: is it safe?

Vol. 42 (3): 418-421 May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2016.03.04


DIFFERENCE OF OPINION

Active surveillance in Gleason 7 intermediate risk prostate cancer: is it safe?
Opinion: No

Nishanth Krishnananthan 1, Nathan Lawrentschuk 1,2,3

1 University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia; 2 Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; 3 Olivia Newton-John Cancer Research Institute, Melbourne, Australia


Keywords: Prostatic Neoplasms; Prostate cancer, familial [Supplementary Concept]; Watchful Waiting; Disease; Therapeutics


 

INTRODUCTION

Active surveillance (AS) is a management strategy for early-stage prostate cancer (PCa) designed to balance early detection of aggressive disease and overtreatment of indolent disease (1). It is advocated as the treatment of choice for favourable-risk disease in several national guidelines (National Comprehensive Cancer Network, National Institute for Health and Clinical Excellence) (2). Despite it’s significant role in low risk PCa, AS is not established as a standard of care for intermediate risk disease. A contemporary registry-based population study in Australia ascertained the treatment trends and patterns of care of 980 men with PCa on AS. It reported that 251 men (8.9%, Median 70.4) with intermediate risk were placed in AS, of whom 53.8% had Gleason score (GS) 3+4 PCa and 10.4% with 4+3 disease (3).

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Metabolic syndrome and prostatic disease: potentially role of polyphenols in preventive strategies. A review

Vol. 42 (3): 422-430, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0095


REVIEW ARTICLE

Metabolic syndrome and prostatic disease: potentially role of polyphenols in preventive strategies. A review

Tommaso Castelli 1, Giorgio Ivan Russo 1, Giulio Reale 1, Salvatore Privitera 1, Mario Chisari 1, Eugenia Fragalà 1, Vincenzo Favilla 1, Sebastiano Cimino 1, Giuseppe Morgia 1

1 Dipartimento di Urologia, Facoltà di Medicina Policlinico, Università di Catania, Italia

ABSTRACT

Benign prostatic hyperplasia and prostate cancer are two common urological diseases of the elderly. Scientific community has always looked for a link that could explain the correlation between the two diseases and the role of chronic inflammation in the pathogenesis of BPH and PCa. As shown by the reports of the two diseases relationship with oxidative stress and metabolic syndrome, the use of compounds with antioxidant action could therefore affect both the symptoms and their onset. Polyphenols appear to act not only against oxidative stress but also at different levels. The aim of this review is to evaluate the role of the most important polyphenols on these two urological diseases. As antioxidants these compounds seems to have a direct action on the cell cycle and hormone function, important for both prostate cancer and BPH. Despite a large number of articles about the relationship of the polyphenols with prostate cancer, very little evidence exists for BPH. Additional clinical trials or meta-analysis are necessary on this topic.

Keywords: Oxidative Stress; Prostatic Hyperplasia; Prostatic Neoplasms; Polyphenols

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Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

Vol. 42 (3): 431-437, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0380


ORIGINAL ARTICLE

Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort
Renato B. Corradi 1, Gustavo Jaime Climaco Galvão 1, Gabriel M. Oliveira 1, Vinicius F. Carneiro 1, Wadson Gomes Miconi 1, Paulo Guilherme Oliveira Salles 1, Walter Luiz Ribeiro Cabral 1, Carlos Corradi 2, Andre Lopes Lopes Salazar 1

1 Departamento de Urologia, Intituto Mario Penna, Belo Horizonte, MG, Brasil; 2 Departamento de Urologia, Hospital das Clínicas UFMG, Belo Horizonte, MG, Brasil

ABSTRACT      

Introduction and Objective: Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control.
Patients and Methods: We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the compli¬cations within 30 days of surgery.
Results: We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The me¬dium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients.
Conclusions: In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pa¬thologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

Keywords: Cystectomy; Lymph Node Excision; Urinary Bladder Neoplasms; Therapeutics

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4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results

Vol. 42 (3): 438-448, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0323


ORIGINAL ARTICLE

4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results

Humberto do Nascimento Barbosa Junior 1, Tiberio Moreno Siqueira Junior 1, Françualdo Barreto 2, Leonardo Gomes Menezes 3, Mauro José Catunda Luna 3, Adriano Almeida Calado 1
1 Departamento de Urologia da Universidade de Pernambuco – Recife, PE, Brasil; 2 Departamento de Urologia, IMIP, Recife, PE, Brasil; 3 Serviço de Urologia, Memorial São José Hospital, Recife, PE, Brasil

ABSTRACT        

Introduction: There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few se¬ries, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer.
Objective: To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon.
Patients and methods: A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out.
Results: The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, esti¬mated blood loss and the withdrawal time of the urinary catheter.
Conclusion: The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity.

Keywords: Endoscopy; Prostatectomy; Learning; Minimally Invasive Surgical Procedures

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Evaluation of PCA3 and multiparametric MRI’s: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL

Vol. 42 (3): 449-455, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0155


ORIGINAL ARTICLE

Evaluation of PCA3 and multiparametric MRI’s: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL

Sezgin Okcelik 1, Hasan Soydan 2, Ferhat Ates 2, Ufuk Berber 3, Hasan Saygin 4, Güner Sönmez 4, Kenan Karademir 2
1 Department of Urology, Beytepe Military Hospital, Ankara, Turkey; 2 Department of Urology Haydarpasa Training Hospital, Istanbul, Turkey; 3 Department of Pathology, Corlu Military Hospital, Tekirdag, Turkey; 4 Department of Radiology, Haydarpasa Training Hospital, Istanbul, Turkey

ABSTRACT

Objective: To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE).
Materials and Methods: PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient un¬derwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted.
Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated.
Results: 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams.
Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%.
NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively.
Conclusion: Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

Keywords: prostate cancer antigen 3, human [Supplementary Concept]; Prostate; Magnetic Resonance Imaging

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Safety and feasibility of radiofrequency ablation for treatment of Bosniak IV renal cysts

Vol. 42 (3): 456-463, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0444


ORIGINAL ARTICLE

Safety and feasibility of radiofrequency ablation for treatment of Bosniak IV renal cysts

Marcos Roberto de Menezes 1,2, Publio Cesar Cavalcante Viana 1,2, Tássia Regina Yamanari 2, Leonardo Oliveira Reis 3, William Nahas 4
1 Serviço de Intervenção Guiada de Radiologia e Imagem, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, SP, Brasil; 2 Serviço de Intervenção Guiada de Radiologia e Imagem, Hospital Sírio Libanês, São Paulo, SP, Brasil; 3 Departamento de Urologia, Pontifícia Universidade Católica de Campinas, PUC – Campinas, Campinas, SP, Brasil; 4 Departamento de Urologia, Hospital das Clínicas da Faculdade de Medicina Universidade de São Paulo, SP, Brasil

ABSTRACT

Purpose: To describe our initial experience with radiofrequency ablation (RFA) of Bos¬niak IV renal cysts.
Materials and Methods: From 2010 to 2014, 154 renal tumor cases were treated with percutaneous thermal ablation, of which 10 cases (6.4%) from nine patients were com¬plex renal cysts and were treated with radiofrequency ablation.
Results: All complex cysts were classified as Bosniak IV (four women and five men; mean age: 63.6 yrs, range: 33–83 years). One patient had a single kidney. Lesion size ranged from 1.5 to 4.1cm (mean: 2.5cm) and biopsy was performed on four cysts immediately before the procedure, all of which were malignant (two clear cell and two papillary carcinoma). Mean volume reduction of complex cysts was 25% (range: 10–40%). No patients required retreatment with RFA and no immediate or late compli¬cations were observed. The follow-up of Bosniak IV cysts had a median of 27 months (interquartile range [IQR], 23 to 38) and no recurrence or significant loss of renal function were observed.
Conclusions: Mid-term follow-up of the cases in our database suggests that image¬-guided percutaneous RFA can treat Bosniak IV cysts with very low complication rates and satisfactorily maintain renal function.

Keywords: Safety; Feasibility Studies; Catheter Ablation; Renal cysts and diabetes syndrome [Supplementary Concept]

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Prostate MRI: a national survey of Urologist’s attitudes and perceptions

Vol. 42 (3): 464-471, May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0235


ORIGINAL ARTICLE

Prostate MRI: a national survey of Urologist’s attitudes and perceptions

Brandon J. Manley 1, John A. Brockman 1, Valary T. Raup 1, Kathryn J. Fowler 2, Gerald L. Andriole 1
1 Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine St. Louis, USA; 2 Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA

ABSTRACT

Introduction: The use of multi-parametric (MP) MRI to diagnose prostate cancer has been the subject of intense research, with many studies showing positive results. The purpose of our study is to better understand the accessibility, role, and perceived accu¬racy of MP-MRI in practice by surveying practicing urologists.
Materials and Methods: Surveys were sent to 7,400 practicing American Urological Association member physicians with a current email address. The survey asked demo¬graphic information and addressed access, accuracy, cost, and role of prostate MRI in clinical practice.
Results: Our survey elicited 276 responses. Respondents felt that limited access and prohibitive cost of MP-MRI limits its use, 72% and 59% respectively. Academic uro¬logists ordered more MP-MRI studies per year than those in private practice (43.3% vs. 21.1%; p<0.001). Urologists who performed more than 30 prostatectomies a year were more likely to feel that an MP-MRI would change their surgical approach (37.5% vs. 19.6%, p-value=0.002). Only 25% of respondents agreed or strongly agreed that MP-MRI should be used in active surveillance. For patients with negative biopsies and elevated PSA, 39% reported MP-MRI to be very useful.
Conclusions: Our study found that MP-MRI use is most prominent among practitioners who are oncology fellowship-trained, practice at academic centers, and perform more than 30 prostatectomies per year. Limited access and prohibitive cost of MP-MRI may limit its utility in practice. Additionally, study participants perceive a lack of accuracy of MP-MRI, which is contrary to the recent literature.

Keywords: Prostate; Magnetic Resonance Imaging; Prostatic Neoplasms

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